Making It Easier to Swallow

By Michele Hollow @michelechollow
March 13, 2017

Howard Rosenberg implemented an innovative dining service program using xanthan-based thickeners with dysphagia residents so they could dine with dignity.

Most of us don’t think about swallowing food and drinks. For those with dysphagia ― a severe swallowing disorder brought on by Alzheimer’s, a stroke, Parkinson’s disease, multiple sclerosis, brain injuries, and other medical conditions ― the disease can lead to a cascade of complications, such as dehydration, malnourishment, aspiration, or foods and beverages going down the wrong way, making every meal and sip of water feel like drowning.

It’s known that the only way many of those with dysphagia can swallow safely is to adopt a diet of thickened liquids, which are often unappealing, leading to further dehydration and malnutrition. Recent innovations with xanthan gum in beverage thickeners have improved the taste of thickened drinks and greater absorption of thickened medications and supplements.


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Howard Rosenberg, former director of dining services at Amsterdam Nursing Home in New York City, observed these issues with patients with dysphagia and decided to change almost everything they were doing related to what and how they served residents at mealtime. By using xanthan-based thickeners with dysphagia residents at the nursing home, he saw impressive results.

Hydration increased by 44 percent, and caloric consumption at meals increased by 23 percent. The Amsterdam staff members reported receiving fewer requests for help at mealtime and found that the residents looked forward to breakfast, lunch, and dinner.

“The reason I did this was to restore a resident’s level of dignity and independence,” Rosenberg said. “They have been independent for most of their lives, and at mealtimes they don’t want a caretaker to do everything for them.”

The change at mealtimes was significant. Before implementing this technique, certified nursing assistants stood over the residents, pouring and stirring a thickener into their drinks. Many of the patients with dysphagia don’t like being reminded that they have difficulty swallowing. This normalized their diet. They’re eating and drinking more, which cuts down their risks for so many complications associated with dehydration and malnutrition.

The thickener is used in coffee, water, soups, broths, and other liquids. “We’ve found less stress at mealtime,” Rosenberg explained. “The residents with dysphagia increased their fluid intake, looked forward to and enjoyed their meals, and re-established a personal level of independence during meal service.”

“And for residents who require assistance at mealtimes,” Rosenberg continued, “they no longer needed to be coaxed or encouraged at each sip. Plus, our more independent residents were able to self-feed more easily and safely.”

For residents with dementia who can’t communicate if they need more liquids, the caregivers at the nursing home noticed that their residents are drinking more. “All of the patients with dysphagia seem to enjoy their meals more,” Rosenberg said.

Rosenberg, who recently moved to Resort Nursing Home in Far Rockaway, N.Y., is hoping to implement the program there. “When you come into a new facility, you have to crawl before you can walk,” he said. “I’m an operations person. I have to show how this system is more cost effective than what’s currently in place.”

Rosenberg noticed that the popularity of the beverages lead to significant savings. “We realized a savings of approximately $1,000 per resident per year,” he explained.

Saving money and improving the health of the residents makes this a win-win situation. What makes Rosenberg really happy is that “the residents are in control at mealtime and they are also enjoying their meals.”

For more information about this process and to see Rosenberg at Amsterdam Nursing Home, you can watch this:


March 13, 2017

Reviewed By:  

Janet O’Dell, RN